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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Cost recommendation under uncertainty in IQWiG’s efficiency frontier framework
Authors: Corro Ramos, Isaac
Lhachimi, Stefan K.
Gerber-Grote, Andreas
Al, Maiwenn J.
DOI: 10.21256/zhaw-3626
Published in: Medical Decision Making
Volume(Issue): 37
Issue: 2
Pages: 162
Pages to: 172
Issue Date: 2016
Publisher / Ed. Institution: Sage
ISSN: 0272-989X
Language: English
Subjects: Decision analysis; Detailed methodology : probabilistic sensitivity analysis; Simulation methods; Antidepressive Agents; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Making; Germany; Human; Models, Econometric; Model, Statistical; Uncertainty
Subject (DDC): 610: Medicine and health
658.4: Executive Management
Abstract: Background: The National Institute for Quality and Efficiency in Health Care (IQWiG) employs an efficiency frontier (EF) framework to facilitate setting maximum reimbursable prices for new interventions. Probabilistic sensitivity analysis (PSA) is used when yes/no reimbursement decisions are sought based on a fixed threshold. In the IQWiG framework, an additional layer of complexity arises as the EF itself may vary its shape in each PSA iteration, and thus the willingness-to-pay, indicated by the EF segments, may vary. Objectives: To explore the practical problems arising when, within the EF approach, maximum reimbursable prices for new interventions are sought through PSA. Methods: When the EF is varied in a PSA, cost recommendations for new interventions may be determined by the mean or the median of the distances between each intervention’s point estimate and each EF. Implications of using these metrics were explored in a simulation study based on the model used by IQWiG to assess the cost-effectiveness of 4 antidepressants. Results. Depending on the metric used, cost recommendations can be contradictory. Recommendations based on the mean can also be inconsistent. Results (median) suggested that costs of duloxetine, venlafaxine, mirtazapine, and bupropion should be decreased by €131, €29, €12, and €99, respectively. These recommendations were implemented and the analysis repeated. New results suggested keeping the costs as they were. The percentage of acceptable PSA outcomes increased 41% on average, and the uncertainty associated to the net health benefit was significantly reduced. Conclusions: The median of the distances between every intervention outcome and every EF is a good proxy for the cost recommendation that would be given should the EF be fixed. Adjusting costs according to the median increased the probability of acceptance and reduced the uncertainty around the net health benefit distribution, resulting in a reduced uncertainty for decision makers.
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
Departement: Health Professions
Appears in Collections:Publikationen Gesundheit

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